Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial

BACKGROUND: The current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. OBJECTIVES: The purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. METHODS: The FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children's parents/caregivers, were randomized to receive either an "individual-focused" or "peer-to-peer-based" lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. RESULTS: A total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: -0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. CONCLUSIONS: Although overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.AGENCIA FINANCIADORA: The American Heart Association, under grant No 14SFRN20490315, funded this study. R.F-J is a recipient of funding from the European Union Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 707642. The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia, Innovación y Universidades (MCNU) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).S

Ethnic Disparities in Metabolic Syndrome Among Caregivers of Preschool Children in a Community-Based Trial

American Heart Association Scientific Congress 2017. Anaheim, USA. November 11-15, 2017.Introduction: Obesity and dyslipidemia are increasingly prevalent, disproportionately affecting low-income families. We studied the presence of metabolic syndrome (MetS) by ethnicity among caregivers of preschool children in Harlem, New York. Methods: We analyzed 553 Hispanic and non-Hispanic black caregivers of children in Head Start preschools at their baseline assessment enrolling in a community-based lifestyle intervention. MetS was defined by at least 3 of the following: waist circumference >102/88 cm for men/women respectively, systolic/diastolic blood pressure ≥130/85 mm Hg, serum glucose > 100 mg/dL, triglycerides >150 mg/dL, or HDL < 40/50 mg/dL for men/women. Univariate logistic regression was used to determine significant predictors of MetS, and a multivariable logistic regression model was constructed to predict MetS among participants. Results: The mean age of participants was 37.5±11.3 years old. 34.4% Hispanic and 24.6% non-Hispanic black participants had MetS (p=0.015). This difference in the odds of MetS was primarily driven by a higher incidence of elevated triglycerides, elevated glucose, and low HDL in Hispanic participants, whereas hypertension was more common among black participants. Non-metabolic predictors of MetS in this population included age (OR 1.89 for every 10-year increase in age, p<0.0001, 95% CI: 1.58-2.26), education level (some college or more as compared to high school or less, OR 0.65, p=0.036, 95% CI 0.43-0.97), and Hispanic ethnicity as compared to non-Hispanic black (OR 1.64, p=0.021, 95% CI: 1.08-2.49). These predictors remained statistically significant after additionally adjusting for gender, household income, and tobacco use. Conclusions: Hispanic caregivers had significantly higher odds of MetS as compared to non-Hispanic black caregivers. The overall prevalence of MetS is high, demonstrating an alarming trend among low-income adults enrolled in an urban community-based trial.N

Racial Disparities in Early Subclinical Atherosclerosis: Insights from the FAMILIA Study

American Heart Association Scientific Sessions 2018. Chicago, USA. November 10-12, 2018.Introduction: African-Americans are at a greater risk of cardiovascular (CV) events. Differential race vulnerability to early subclinical atherosclerosis disease is likely, and yet few studies have addressed this relationship. Objective: To study the impact of race on the presence of early subclinical atherosclerosis in adults enrolled in the “Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health” (FAMILIA) study. Methods: A total of 431 adults, including parents/caregivers and staff, recruited in the FAMILIA study from 15 Head Start preschools in Harlem (New York) and with no previous history of CV disease, underwent bilateral carotid and femoral three-dimensional vascular ultrasound. The 10-year Framingham CV risk was calculated, and the relationship between race and the presence of subclinical atherosclerosis was analysed by using multivariate logistic regression models and receiver operating characteristic (ROC) curves. Results: Mean age of participants was 38.1±11.1 years, 83% female, 66% Hispanic/Latino, 34% non-Hispanic Black. Mean 10-year Framingham CV risk was 3.8% with no significant differences by race. The overall prevalence of subclinical atherosclerosis was 8.6%, and was significantly higher in non-Hispanic Blacks (12.2%) than in Hispanic/Latino participants (6.7%) [Figure 1A]. Adjusted by 10-year Framingham CV risk, non-Hispanic Blacks were more likely to have subclinical atherosclerosis than Hispanic/Latino (odds ratio = 2.18; 95% CI, 0.97 to 4.91; p = 0.06). The model including 10-year Framingham CV risk and race showed good discriminatory capacity for the prediction of subclinical CV disease with an area under the ROC curve of 0.89 (95% CI, 0.85 to 0.91) [Figure 1B]. Conclusion: For the same predicted CV risk, non-Hispanic Blacks seem more vulnerable to early subclinical atherosclerosis as compare to Hispanic/Latino, placing them at enhanced risk for clinical CV disease. These results may be important for the implementation of prevention programs in different populations

Social determinants of lifestyle and cardiovascular health in a minority community study for promotion of health

American College of Cardiology 67th Annual Scientific Session 2018. Orlando, USA. March 10-12, 2018